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Fill and Sign the First Regular Session House Bill No 595 95th Form

Fill and Sign the First Regular Session House Bill No 595 95th Form

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Unconditional Waiver and Release of Lien Upon Progress Payment Page 1 of 1 UNCONDITIONAL WAIVER AND RELEASE OF LIEN UPON PROGRESS PAYMENT (Mo.S.Ann § 429.005) On this _____ day of ________________ , 20______,the undersigned lienor, in consideration of the sum of $ __________________, hereby waives and releases his or her lien and right to claim a lien for labor, services or materials furnished through ____________________, 20_____, to ___________________________________ (customer) on the job of __________________________________ (owner of property) to the following described property: ________________________________________________________________________ ________________________________________________________________________ _________________________________________________________________________________________.This waiver and release does not cover any retention or labor, services, or materials furnished after the date specified. __________________________________Signature of Lien Holder__________________________________ Type or Print Name STATE OF MISSOURICOUNTY OF ______________ On this _____ day of ______________ , 20_____, before me personally appeared ___________________________________, to me known to be the person described in and who executed the foregoing instrument, and acknowledged that he/she executed the same as his/her free act and deed. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my official seal in the county and state aforesaid, the day and year first above written. ______________________________ Notary PublicMy commission expires: _______________

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